I started off on half a grain of Nature-Throid about 3 weeks ago and increased my dose to 1 grain after two weeks. In terms of subjective response, it hasn't had a positive effect - if anything I feel worse, though that may due to a cold I've had on-off for the last two weeks or so (off now I hope). None of the subjective symptoms - primarily tiredness/lack of energy - have improved.

Objectively, my resting pulse rate seems to have increased and is now usually 60 during the day - though taking it now, late in the evening, it is back down to 50. By the way, how bad is a pulse rate of 50 - is this something I can take to my doctor and be taken more seriously? I am reasonably fit when it comes to running (no superman though), but would that explain it?

Body temperature (during the day - I know I should take it just after waking up) seemed to have improved initially - going to 36.6 and even 36.7 - but is now again coming in at 36.5 and often lower. Though I'm not sure if this electronic thermometer can be trusted. After it beeps, I leave it for a good few minutes longer because the reading keeps rising before it truly settles, so I hope this is giving a more accurate reading. (If I take the reading when it beeps, then it is like 35.5.) My reading now is 36.3-36.4 (corresponding with the low pulse rate I guess).

Any suggestions?

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You need to give the thyroid hormones much longer to get into your cells and thus hopefully make you feel better. Three weeks on NDT, if you have been ill for some time, is a very short time to see improvement.

TAke one step at a time and keep a note of any improvement or symptoms that you notice have cleared completely. Once the body temperature improves, you should start to see a difference.

As I've said on one of the other postings, have a read of Peter WArmingham's theory on the Thyroid UK site. Initially on a low dose of hormone replacement, the body stops producing so much and so you are back to square one. As the dose increases, it will finally come to a point where the intake of NDT is more than the hormone produced by your body.

I thought that because NDT contains T3 the effects would be noticeable fairly quickly (sooner than with T4 alone).

Which page on Thyroid UK are you referring to? I would be interested in reading an explanation as to why the thyroid would slow down even though presumably not enough hormones are being provided from the NDT.

Effects might well be noticeable in a short period. I noticed some changes within minutes of my first tablet. Improvements are often individually small but cumulative.

I am on a small dose (currently 50mcg thyroxine) and can say that over the months have noticed tiny things here and there - not major changes. For example, one day I realised I wasn't needing my work glasses (for the computer screens), another day I noticed my hair was growing better, and so on. And most days there is no noticeable change from the day before. But overall there has been a marked improvement.

I've often suggested that it might take as long to recover as it took to deteriorate in the first place. And for many this will be years. (No scientific basis for this - it just seems that the stories I read all point in this direction.)

Keep going. And really don't panic about minor changes in pulse or temperature - and you might need more - or a different balance. But expect slow changes.#

I'll keep going and hopefully I will eventually notice some improvements.

I probably had too high expectations in terms of how quickly it will work. I know that medications often take time to work and sometimes you feel worse before feeling better - maybe that's what is going on here.

I am just reading the paper linked to by Muffy. It is really interesting and if I understand things correctly a suppressing feedback loop does seem plausible during treatment at least in central hypothyroidism (not sure about primary though - why should there be negative feedback if serum t3 and t4 is not at the optimum point in this case?).

No - I didn't try > 50. I am one of those oddballs - my fT4/TSH came back into sensible ranges quite quickly. I have no antibodies. And even at diagnosis I was only at around TSH = 5.75.

Maybe I do need an increment but at present I feel comfortable with being able to add a bit if needed. My focus is more on the cause of nausea which I am convinced is based in my thyroid and/or parathyroids - but having difficulty getting an ultrasound scan.

Does your GP not want to give you a referral for the US? By the way, you can get ultrasound/mri/ct scans quite cheaply in Germany and not surprisingly they have really good technology. Have a look at mri-abroad.de - not sure if they do US, but I used them before for an MRI and they where really good.

Since under-dosing is a possibility given all the arguments being made, maybe you should try increasing to see what happens with the nausea. Unless you have a heart problem it doesn't appear to be that dangerous to go slightly hyper, so there shouldn't be much risk. You're obviously far more researched in these matters, but that's my understanding.

My GP referred me for a US. That was thrown out by the X-ray/US dept. as they now only take US requests from the newly created "Thyroid Clinic". (We knew nothing of the existence of this clinic until I rang to find why I had not yet heard about an appointment for a US. Nor had my GP.)

I could pay for one (and might yet do so) but still need a GP referral - and he is on holiday at the moment.

My particular form feels like something is putting some pressure either on my oesophagus or on a nerve somewhere close by - not full 'stomach' nausea. Unpleasant but not unbearable.

I've noticed no change whatsoever in this nausea between before diagnosis, through diagnosis up to being on a reasonable dose (for me, for now) - just seem to have a bad day, a good day or an inbetween day in random order.

No idea. We have heard of Thyroid Clinics in other areas in the past - but this appears to have been established just as they were trying to cut costs which makes you wonder what the motivation was?

On the basis that this is consultant-led it looks to me like it is a way of blocking GP requested investigations. After all, most thyroid patients never get to see a consultant about their thyroids.

Going abroad, even as the cheapest foot passenger, would be so much more expensive than a private US here. Last price I saw was £80 for a thyroid US by a local sonographer working out of the NHS hospital itself!

My TSH was quite low to begin with (about 0.5 - along with low t4 indicating central hypothyroidism) so could full TSH suppression occur as I increase the dose? If so, do you know if full TSH suppression is reversible in case the NDT doesn't help and I want to stop treatment?

In case anyone comes across this thread with the same question regarding TSH suppression, I have found the following studies which suggest that the hypothalamic-pituitary-thyroid axis returns to its previous state following thyroid hormone therapy.